Children's Orthopaedics Flashcards
how does knee alignment change during childhood?
newborn has genu varus (bow legged)
1.5 - 2 yrs = straight
2.5 yrs = slight genu valgus
4-6 yrs = straight allignment
what indicates that an abnormality may be a problem and not just something that will resolve?
unilateral
what is the definition of a deformity?
something likely to persist and cause physical or mental health problems later in life
how does bone grow longitudinally?
from the growth plate (physis) by echondral ossification
how does bone grow circumferentialy?
from the periosteum by appositional growth
females lose bone density at a faster rate than males, true or false?
false
both at the same rate but males start with a higher bone density
what happens at the growth plate?
stacking of chondrocytes - they die and act as scaffold for new bone laid down by osteoblasts
which part of the bone is most vulnerable to fracture in childhood?
growth plate?
what factors affect the growth plate?
diet sunshine - vit D&A injury illness hormones (growth hormone)
is short stature always pathological?
no
only 1 in 5 children 2SD below normal have a pathological reason
growth is very variable <3 y/o
normal movement at 6-9 months?
sits alone
crawls
normal movement at 8-12 months?
stands
normal movement at 14-17 months?
walking
normal movement at 24 months?
jumping
normal movement at 3 years?
can manage stairs alone
normal cerebral development at 1-6 months?
loss of primitive reflexes - moro, grasp, stepping, fencing
normal cerebral development by 2 months?
head control
normal cerebral development by 9-12 months?
few words
normal cerebral development by 14 months?
feeds self
uses spoon
normal cerebral development by 18 months?
stacks 4 blocks
understands 200 words
normal cerebral development by 3 years?
potty trained
give 4 common variations of normal in children
genu varum or valgum
intoeing
flat feet
curly toes
what is varum?
bow legged
what is valgum?
knock kneed
how does varum/valgum vary with age?
infant = varuk
18 months = straight
3.5 years = valgum
7 years = straight
who is genu varum normal in?
age <2
persisting varum can run in families
what are 5 abnormal causes for genu varum?
skeletal dysplasia rickets - Vit D deficiency tumour blounts disease trauma - physeal injury
what is blounts disease?
arrest of growth at the medial tibia growth plate causing growth disorder and varum deformity
what does blounts disease look like?
typical beak like protrusion on X ray
what can cause genu valgum?
tumours
rickets
neurofibromatosis
idiopathic
when can genu valgum be normal?
until around 3.5 years
when would genu valgum require referral or treatment?
if asymmetric, painful or severe
if >8cm intramalleolar distance at age 11 - need surgery
what is intoeing?
child walks with toes pointing in
“pigeon toed”
how can you exaggerate intoeing?
running
what can cause intoeing?
femoral neck anteversion
internal tibial torsion
metatarsus addctus
combination
what is femoral neck anteversion and what is the classical presentation?
inward twisting of the femur (usually points anteriorly)
children sitting in the “W” position
how can femoral neck anteversion be tested for?
get child to lie prone
bend knees and rotate legs outwards
what can femoral neck anteversion cause risk of?
patellofemoral problems
what is internal tibial torsion and how is it treated?
inward twisting of the tibia
usually seen in toddlers <3 but vast majority resolve by 6 yrs
usually none needed, surgery done in very rare cases
what is metatarsus adductus?
curving of the foot towards the medial side
benign and usually resolves
what is usually done for intoeing?
no treatment
find cause and reassure
might chart, photograph and review
what is flat feet?
medial arch doesn’t develop in childhood as tibialis posterior strengthens
what are the symptoms of flat feet?
usually none
no proven consequences
how do you test flat feet?
stand on toes to determine if flexible or fixed
- flexible = arch appears
- fixed = stays flat
calf tightness assessment
what can cause flexible and fixed flat feet?
flexible - ligament laxity or tightness
fixed - bony connection known as tarsal coalition
what must you remember to check with anterior knee pain?
hips
what is curly toes?
toes (usually 3rd or 4th) are scrunched up
common in young children and usually resolves by 6 yrs
